Use of a Respiratory Clinical Score among Different Providers

Lenna L. Liu, Margaret M. Gallaher, Robert Davis, Carolyn M. Rutter, Toby C. Lewis, Edgar K. Marcuse

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0. 19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.

Original languageEnglish (US)
Pages (from-to)243-248
Number of pages6
JournalPediatric Pulmonology
Volume37
Issue number3
DOIs
StatePublished - Mar 2004
Externally publishedYes

Fingerprint

Bronchiolitis
Dyspnea
Auscultation
Asthma
Respiratory Rate
Nurses
Physicians
Hospitalized Child
Process Assessment (Health Care)
Observer Variation
Urban Hospitals
Respiratory Sounds
Tertiary Healthcare
Child Care
Tertiary Care Centers

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Liu, L. L., Gallaher, M. M., Davis, R., Rutter, C. M., Lewis, T. C., & Marcuse, E. K. (2004). Use of a Respiratory Clinical Score among Different Providers. Pediatric Pulmonology, 37(3), 243-248. https://doi.org/10.1002/ppul.10425

Use of a Respiratory Clinical Score among Different Providers. / Liu, Lenna L.; Gallaher, Margaret M.; Davis, Robert; Rutter, Carolyn M.; Lewis, Toby C.; Marcuse, Edgar K.

In: Pediatric Pulmonology, Vol. 37, No. 3, 03.2004, p. 243-248.

Research output: Contribution to journalArticle

Liu, LL, Gallaher, MM, Davis, R, Rutter, CM, Lewis, TC & Marcuse, EK 2004, 'Use of a Respiratory Clinical Score among Different Providers', Pediatric Pulmonology, vol. 37, no. 3, pp. 243-248. https://doi.org/10.1002/ppul.10425
Liu, Lenna L. ; Gallaher, Margaret M. ; Davis, Robert ; Rutter, Carolyn M. ; Lewis, Toby C. ; Marcuse, Edgar K. / Use of a Respiratory Clinical Score among Different Providers. In: Pediatric Pulmonology. 2004 ; Vol. 37, No. 3. pp. 243-248.
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